Nail Bed Reconstruction Surgery in Orthopedics - Orthopedics

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Nail bed reconstruction surgery


Dear Dr.
Tan,
What is nail bed reconstruction? Is it necessary to include bone repair, grafting, and microsurgical techniques for it to be considered nail bed reconstruction? I would greatly appreciate your guidance on this matter.
Thank you.

Xiao Meng, 40~49 year old female. Ask Date: 2010/04/30

Dr. Tan Zhuowen reply Orthopedics


Hello, Xiao Meng: Ingrown toenails that become infected are common among individuals with flat feet, those who wear shoes that are too tight, and diabetic patients, leading to a condition known as "paronychia." The simplest preventive measure for paronychia is to trim the toenails straight across, which can help prevent the sides of the toenails from growing into the skin.
Treatment for paronychia varies depending on whether it is acute or chronic and whether there are complications such as purulent granuloma.
The traditional method for toenail removal involves injecting anesthesia into the big toe, and once the anesthesia takes effect, surgical instruments are used to lift the toenail for partial trimming, without addressing the nail bed and growth point beneath the nail.
However, this method only addresses the symptoms, with a recurrence rate of about 70 to 80%.
New surgical techniques allow for the reshaping of the nail bed and nail plate, as well as the removal of part of the growth point beneath the skin, effectively reducing the width of the nail plate.
This procedure is known as nail bed reconstruction.
Dr.
Tan Chew-Wen from Orthopedics.

Reply Date: 2010/04/30

More Info


Nail bed reconstruction surgery is a specialized procedure in orthopedics that focuses on repairing and restoring the nail bed, which is the skin beneath the nail plate. This surgery is often necessary after traumatic injuries, such as lacerations or avulsions, that compromise the integrity of the nail bed and can lead to complications like nail deformities or loss of the nail altogether.

The nail bed is composed of delicate tissues that support the growth of the nail. When injuries occur, they can disrupt not only the nail bed but also the surrounding structures, including the matrix (the tissue that produces the nail) and sometimes even the underlying bone. Therefore, the complexity of the reconstruction depends on the extent of the injury.

1. Understanding the Procedure: Nail bed reconstruction can involve various techniques, depending on the severity of the injury. In cases where the nail bed is partially or completely avulsed, the surgeon may need to reattach the nail bed to the underlying structures. This can be done through direct suturing of the nail bed edges. If the injury is more severe and involves loss of tissue, grafting techniques may be employed.
2. Bone Repair and Grafting: While not all nail bed reconstruction surgeries require bone repair or grafting, it is crucial in cases where the injury has also affected the underlying bone structure. If the injury has caused a fracture or significant bone loss, the surgeon may need to perform a bone graft to restore the structural integrity of the finger. This can involve using bone from another part of the body or synthetic materials.

3. Microsurgical Techniques: In more complex cases, especially those involving significant tissue loss, microsurgical techniques may be necessary. This involves using a microscope to perform intricate repairs and reconstructions, allowing for precise handling of small blood vessels and nerves. Microsurgery can improve the chances of successful healing and nail regrowth.

4. Postoperative Care and Recovery: After the surgery, patients typically undergo a rehabilitation process that may include physical therapy to regain mobility and function in the affected finger. The healing process can take several weeks to months, depending on the severity of the injury and the complexity of the reconstruction.

5. Outcomes and Considerations: The success of nail bed reconstruction surgery largely depends on the timing of the intervention, the extent of the injury, and the techniques used. Early intervention generally leads to better outcomes. Patients should also be aware of potential complications, such as infection, scarring, or nail deformities, which can occur despite the best surgical efforts.

In summary, nail bed reconstruction surgery is a vital procedure for restoring function and aesthetics to the nail and finger after injury. While it may not always require bone repair, the involvement of bone structures can significantly influence the surgical approach. Consulting with a qualified orthopedic surgeon who specializes in hand surgery is essential for determining the best course of action based on individual circumstances.

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